不同超声影像诊断手段在良恶性TN患者中的应用效果研究

Research on application effects of different ultrasonic imaging methods on patients with benign or malignant thyroid nodules

目的 探讨不同超声影像诊断手段对良恶性甲状腺结节（TN）的鉴别诊断价值。方法 选择2011年1月-2014年5月在我院住院行手术治疗的TN患者84例,术前接受高分辨率超声、超声弹性成像或超声造影3种检查,回顾性分析检查结果的准确性、特异性等指标。结果 高分辨率超声对鉴别良恶性TN有意义的指标为结节回声不均、形态不规则、边界不清、纵横比≥1、结节内细小点状钙化以及结节低回声;恶性病变组织的超声弹性成像分级评分明显高于良性病变组织（P〈0.05）;超声造影有意义的指标为强化边界不清、强化形态不规则。高分辨超声诊断良恶性TN的特异性、敏感性、阴性预测率和阳性预测率分别为77.63%、80.02%、84.42%、71.79%,准确性达78.64%;弹性成像分别为83.72%、48.60%、69.55%、68.14%,准确率达69.04%;超声造影分别为82.48%、68.64%、75.04%、77.37%,准确率达76.84%。3种超声诊断技术比较,高分辨率超声具有较好的准确性和敏感性,而其他两种检查方法的特异性较好。结论 高分辨率超声对良恶性TN的鉴别诊断具有很高的准确性,超声弹性成像和超声造影的特异性较好。若选用高分辨率超声与超声弹性成像或超声造影联合检查诊断,能够降低TN恶性病变的漏诊率和误诊率。

Objective To explore the application value of different ultrasonic imaging methods in the diagnosis of patients with benign or malignant thyroid nodules （TN）. Methods Eighty four patients with TN who received the operation in our hospital between January 2011 and May 2014 were examined by high resolution ultrasound, ultrasonic elasticity imaging, or uhrasonic contrast before the surgery. A retrospective analysis was made in the indexes of the examination results such as the accuracy, specificity, etc. Results The useful indicators of the high resolution ultrasound for the diagnosis of benign or malignant TN were uneven nodular echo, irregular shape, unclear boundary, the aspect ratio≥ 1, small pnnctate calcification in nodules, and hypoechoic nodules. The ultrasonic elasticity imaging grading scores of malignant lesion tissues were significantly higher than those of the benign lesion tissues （P 〈 0.05）. The useful indicators of ultrasonic contrast were unclear strengthening border and irregular strengthening shape. The specificity, sensitivity, negative predictive value, positive predictive value, and accuracy of high resolution ultrasound for the diagnosis of benign and malignant TN were 77.63%, 80.02%, 84.42%, 71.79%, and 78.64%, respectively. Those indexes of the elasticity imaging were 83.72%, 48.60%, 69.55%, 68.14%, and 69.04%, respectively. Those of the ultrasonic contrast were 82.48%, 68.64%, 75.04%, 77.37%, and 76.84%, respectively. Compared with each other, high resolution ultrasound had better accuracy and sensitivity, while the other two methods had better specificity. Conclusion High resolution ultrasound had a high accuracy for the diagnosis of benign and malignant TN, while the other two methods had better specificity. The selection of high resolution ultrasound combined with ultrasonic elasticity imaging or ultrasonic contrast can reduce the missed diagnosis rate and misdiagnosis rate of TN malignant lesions.